. . Wa'memata DHB

D1 Health 03rd Level 2, 15 Shea Terrace, Takapunq Auckland
Private Bag 93-503, Takap una, A uckland 0740
Telephone: 09 441 8938

Facsimile: 09 486 8924

. I WCIZ'temata 

Best Care for Everyone

 

OBJuly 2018

Dr Ashley Bloomfield
Director General of Health and Chief Executive
Ministry of Health

Email: 
Dear Dr Bloomfield,
I write to bring a number of issues of concern to your attention.

Waitemata DHB hosts one of the National Intellectual Disability Secure Services at Mason Clinic
in Auckland. This service is for hospital level care for people with intellectual disabilities who
have come to the attention of criminal justice system or present with extraordinary high and
complex needs. Pohutukawa Unit, at Mason Clinic provides 10 ?care and rehabilitation? beds
and 2 ?assessment? beds accessible to the Forensic Coordination Services Intellectual
Disability (FCS-ID ?formerly known as NIDCA). Although all beds are administered nationally
by FCS-ID the WDHB beds are primarily servicing half the NZ population living essentially in the
Midlands, Auckland and Northland regions.

The DHB has consistently highlighted concerns over inadequate and geographically unbalanced
availability of hospital level secure beds for people with ID and sought to offer solutions since
2014.

The situation is now severe and we request an urgent response. Since 2008 Pohutukawa unit
has not been expected to manage long term needs of women requiring this level of care due to
the small size of the service and the predatory nature of the behaviours of concern of many of
the male residents. Capital and Coast DHB provided specialist services to this small subgroup
of women from across the county up until recently at which point, without consultation, the
expectations changed. Pohutukawa unit has now had two women admitted in 2018. Both are
having to share bedroom corridors with male care recipients raising significant concerns over
the inappropriate mixing of genders and the negative consequences this is having on both the
females and their male peers. Safety is being managed by the use of increased close
observations which is draining resources and diverting resources from rehabilitation.

Services in Pohutukawa unit are at capacity and bed areas are blocked by the lack of long term
provision for complex individuals on the autistic spectrum ofdisorders who are unable to mix
safely with peers and for whom high intensity staff support is required.

FCS-ID has been requesting WDHB to utilise mental health beds for many individuals who have
dual disabilities but require ID specific services to progress to rehabilitation and lower levels of
security. This not only provides sub-optimal care for these individuals but also blocks access for
people with mental health problems not able to access any other services and this is reflected
in the growing waiting lists of people needing forensic beds in Mason Clinic who are currently
inappropriately in prison. Whilst WDHB would like to continue to be flexible and accommodate
these individuals, the lack of transparency and diversion of resources away from people who
do not have ID is neither appropriate or sustainable.

WDHB has expressed a strong preference for care for local people to be delivered locally and
advocates for people in the northern half of the country to enjoy, at least, equitable access to
services offered elsewhere in the county. The DHB has already expressed its concerns to Jill
Lane and Dr Crawshaw about the consultation processes undertaken to date and the need to
greatly enhance the northern region?s participation in planning and decision making around
proposed individualised service units for high and complex and dual disability individuals
currently underway in the Capital and Coast DHB region.

The have very recently signalled an intention to fund four additional beds to the Northern
regions but, with the additional changes in relation to gender mix, it appears likely these beds
will now need to be used for all purposes including accommodating: youths on assessment,
women throughout their care and rehabilitation, high and complex individuals on the autistic
spectrum of disorders, people requiring very long stay containment rather than true
rehabilitation and people in need of genuine step down provision to bridge the manifest gap
between hospital and community secure services in keeping with the continuum already
offered to individuals in all regions except our own. It is apparent that meeting these diverse
needs in four additional beds is unlikely to be adequate.

WDHB is at a crucial point at present developing our master facilities plan for forensic services
for the region to ensure facilities are fit for purpose, to meet projected needs over the next 25
years and beyond. This is a critical point at which realistic planning for the needs of people
with ID must also be undertaken. We would like to see appropriate and joined up planning for
the future level of need in the northern region, a key principle of which should be northern
clients are cared for close to their homes.

As the Ministry of Health purchase this capacity, we seek your assistance to facilitate urgent
short and longer term planning for this small but extraordinarily complex and under-resourced
group. Waitemata DHB is very willing to plan for the necessary increase in beds, but we are
concerned that the 4 beds in contemplation are not sufficient. We also need further clarity
about long term facilities requirements linked to the DHB long term master plan.

We look forward to working with you and your executive on this matter. Dr Jeremy Skipworth,
our Clinical Director of this service is our key contact person.

Yours sincerely
?yvgy?mg 

Dr Dale Bramley
Chief Executive Officer
Waitemata District Health Board

Cc: Dr Jeremy Skipworth, Clinical Director Regional Forensic Services
Cc: Professor Judy McGregor, Chair of Waitemata District Health Board